ENCEPHALITIS

ENCEPHALITIS

DEFINITION

ENCEPHALITIS is the non suppurative inflammation of brain.

AETIOLOGY

Various viruses may cause encephalitis. They are listed below. Japanese B encephalitis virus (common in our country) Enterovirus.

Herpes simplex and zoster varicella virus.

The west Nile virus and other Arboviruses

AIDS.

Rabies virus.

Influenza.

Mumps virus.

Benign lymphocytic choriomeningitis virus.

Post infectious encephalitis (Hypersensitivity).

CLINICAL FEATURES

Onset: Usually acute but may be gradual.

There may be fever (moderate degree), headache, aches and pains all over the body, myalgia, arthralgia, anorexia, nausea, vomiting, lethargy, gradually there may be stupor or coma. There may be recurrent convulsive seizure. Involuntary movements are present.

Features vary according to the involved virus.

When meninges are involved there may be meningo- encephalitis, and neck stiffness may be present. When spinal cord is also affected in addition i.e. there is encephalomyelits, there will be hemiplegia, quadriplegia and bladder involvement. Plantar reflex is extensor in type, jerks are bisk.

INVESTIGATIONS

Blood count is variable, CSF shows slight increase in pressure, protein is raised, sugar is normal, cells show lymphocytic pleocytosis.

CT scan is usually normal.

In serial examination increasing titres of antibody to the causative viruses may be seen.

For viral antigen PCR should be down.

EEG and MRI may also be helpful.

DIFFERENTIAL DIAGNOSIS

Encephalites should be differentiated from meningitis, Poliomyelitis, metabolic encephalopathis and stroke syndrome. Apart from this the exact causative virus should be searched as far as practicable.

Progress: Very much variable.

TREATMENT

General measures for unconscious patients should be undertaken. These cases are better managed in ITU. Anticonvulsant drugs for convulsion, steroids (Dexa methasone 4-6 mgm 6-8 hourly, support to nutrition should be through Ryle’s tube. Catheter should be used for urine retention. Specific drugs may be given if the underlying agent can be identified. But as it is very difficult Acyclovir inj. 10 mgm/kg 8 hourly IV may be given.

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